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PROVIDER NAME DEGREE/TITLE NPI SIGNATURE DATE receiving commission payments made for referrals from this facility. I understand the aforementioned is strictly prohibited. OWNER NAME CLINIC HOURS IN-HOUSE ANALYZER YES NO CURRENT EMR VENDOR RESULTS INTERFACE PAYOR MIX COMMERCIAL MEDICARE W/C OR AUTO TRANSMISSION OF REPORTS SELF-PAY WEB ACCESS REQUESTED USER ID FOR PORTAL PASSWORD AUTHORIZED USER FULL NAME EMAIL ADDRESS SECURE FAX SUPPLIES INDICATE QUANTITY NEXT TO ITEM SHIP TO REQUISITION FORMS...

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What is acct lab use only?

Acct lab use only refers to account numbers and information that are intended for internal laboratory use only.

Who is required to file acct lab use only?

Anyone with access to the laboratory account information is required to file acct lab use only.

How to fill out acct lab use only?

To fill out acct lab use only, simply input the necessary account information designated for internal laboratory use only.

What is the purpose of acct lab use only?

The purpose of acct lab use only is to ensure that sensitive laboratory account information remains confidential and is only accessible to authorized personnel.

What information must be reported on acct lab use only?

Information such as account numbers, financial data, and other proprietary information related to laboratory accounts must be reported on acct lab use only.

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